Urso S, Pacciani E, Fariello G, Colajacomo M, Fassari F M, Randisi F, Certo A, Liberatore M, Pagnotta G
Servizio di Radiologia, Ospedale Bambino Gesù, Presidio di Palidoro, Roma.
Radiol Med. 1995 Sep;90(3):212-8.
Nonspecific osteomyelitis in children and adolescents can be diagnosed in patients 2 to 16 years old and may present as acute, subacute or chronic. During the last 9 years, 40 pediatric patients (aged 2 to 16 years) affected with extra-axial inflammatory bone lesions were examined. The series of cases was then reviewed. This work was aimed at investigating the role of various imaging modalities: conventional radiology (CR), bone scan with technetium-99 methylene diphosphonate (99mTc-MDP), scintigraphy with technetium-esamethylpropylenaminoxima labelled leukocytes (99mTc-HMPAO), computed tomography (CT) and magnetic resonance imaging (MRI) were used to detect the lesions, to make a differential diagnosis and to assess different disease stages. As for acute osteomyelitis (6 patients), CR showed a lytic lesion, periosteal new bone and soft tissue swelling in 4/6 patients; no abnormalities were demonstrated in the other two. Bone scan, CT and MRI depicted bone involvement. CT and MRI also showed inflammatory lesion spread to surrounding soft tissue. 99mTc-HMPAO scintigraphy was not performed in acute osteomyelitis, because of technical difficulties in performing the exam promptly; thus, the early diagnosis of lesion nature was made with bone biopsy. As for subacute osteomyelitis (23 patients), 99mTc-HMPAO scintigraphy was performed in 8/23 patients and proved to be a highly sensitive method, showing cell clusters and confirming the diagnosis of inflammatory lesion. MRI showed a focal area of intermediate-low signal intensity on T1-weighted sequences, with small focal intralesional areas of low intensity, a low-signal perifocal rim and diffusely low signal of surrounding bone marrow. T2-weighted images showed high signal intensity in both the abscess lesion and bone marrow, the latter probably due to edema. In 5 patients, a paramagnetic contrast agent (Gd-DTPA) was administered during MRI and showed inhomogeneous enhancement of both the inflammatory lesion and surrounding bone marrow. As for chronic osteomyelitis (7 patients), MRI was performed in 5/7 patients. In 4 patients the lesion appeared as a low-signal area on T1-weighted images while T2-weighted images showed an inhomogeneous high-signal area. In the same patients, 99mTc-HMPAO scintigraphy was always positive. In patient 5, the lesion was represented by a low-signal area on both T1 and T2-weighted images, while 99mTc-HMPAO was negative. Therefore, in chronic osteomyelitis, both MRI and 99mTc-HMPAO were useful in detecting both spinal and peripheral bone involvement, which was in some cases asymptomatic at first observation CR, CT (3/4) and MR (4/4) findings extra-axial localizations were similar to those in subacute-chronic forms.
儿童和青少年的非特异性骨髓炎可在2至16岁的患者中诊断出来，可表现为急性、亚急性或慢性。在过去9年中，对40例患有轴外炎性骨病变的儿科患者（年龄在2至16岁）进行了检查。然后对该系列病例进行了回顾。这项工作旨在研究各种成像方式的作用：使用传统放射学（CR）、锝-99亚甲基二膦酸盐骨扫描（99mTc-MDP）、锝-依沙美肟标记白细胞闪烁扫描（99mTc-HMPAO）、计算机断层扫描（CT）和磁共振成像（MRI）来检测病变、进行鉴别诊断并评估不同的疾病阶段。对于急性骨髓炎（6例患者），CR在4/6的患者中显示出溶骨性病变、骨膜新生骨和软组织肿胀；另外两例未显示异常。骨扫描、CT和MRI显示有骨质受累。CT和MRI还显示炎性病变蔓延至周围软组织。由于及时进行检查存在技术困难，急性骨髓炎未进行99mTc-HMPAO闪烁扫描；因此，通过骨活检对病变性质进行了早期诊断。对于亚急性骨髓炎（23例患者），8/23的患者进行了99mTc-HMPAO闪烁扫描，结果证明是一种高度敏感的方法，显示出细胞簇并证实了炎性病变的诊断。MRI在T1加权序列上显示出一个中低信号强度的局灶性区域，病灶内有小的低强度局灶性区域、病灶周围低信号边缘以及周围骨髓弥漫性低信号。T2加权图像显示脓肿病灶和骨髓均为高信号强度，后者可能是由于水肿所致。5例患者在MRI检查期间使用了顺磁性造影剂（钆喷酸葡胺），显示炎性病变和周围骨髓均有不均匀强化。对于慢性骨髓炎（7例患者），5/7的患者进行了MRI检查。4例患者的病变在T1加权图像上表现为低信号区域，而T2加权图像显示为不均匀高信号区域。在同一批患者中，99mTc-HMPAO闪烁扫描始终为阳性。第5例患者的病变在T1和T2加权图像上均表现为低信号区域，而99mTc-HMPAO为阴性。因此，在慢性骨髓炎中，MRI和99mTc-HMPAO在检测脊柱和外周骨受累方面均有用，在某些情况下，初次观察时无症状。CR、CT（3/4）和MR（4/4）在外轴定位的表现与亚急性-慢性形式相似。
